• Arnaud W Thille, François Arrivé, and Sylvain Le Pape.
• Centre Hospitalier Universitaire de Poitiers, Médecine Intensive Réanimation.
• Curr Opin Crit Care. 2024 Oct 24.

Purpose Of ReviewGuidelines recommend systematic performance of a spontaneous breathing trial (SBT) before extubation in ICUs, the objective being to reduce the risk of reintubation. In theory, a more challenging SBT performed with a T-piece may further reduce the risk of reintubation, whereas a less challenging SBT performed with pressure-support ventilation (PSV) may hasten extubation.Recent FindingsRecent findings show that a more challenging SBT with a T-piece or for a prolonged duration do not help to reduce the risk of reintubation. In contrast, a less challenging SBT with PSV is easier to pass than a T-piece, and may hasten extubation without increased risk of reintubation. Although SBT with PSV and additional positive end-expiratory pressure is indeed a less challenging SBT, further studies are needed to generalize such an easy trial in daily practice. Earlier screening for a first SBT may also decrease time to extubation without increased risk of reintubation. Lastly, reconnection to the ventilator for a short period after successful SBT facilitates recovery from the SBT-induced alveolar derecruitment.SummarySeveral recent clinical trials have improved assessment of the most adequate way to perform SBT before extubation.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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